Provider Demographics
NPI:1306409842
Name:MEEKS, TAMAKISHA SHOLANDA
Entity Type:Individual
Prefix:
First Name:TAMAKISHA
Middle Name:SHOLANDA
Last Name:MEEKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5306 W FERDINAND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-1936
Mailing Address - Country:US
Mailing Address - Phone:773-968-9069
Mailing Address - Fax:
Practice Address - Street 1:5117 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4676
Practice Address - Country:US
Practice Address - Phone:630-506-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178014746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional